1275530453 NPI number — TWIN CITY AMBULANCE SERVICE, INC.

Table of content: (NPI 1275530453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275530453 NPI number — TWIN CITY AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWIN CITY AMBULANCE SERVICE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275530453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 NOLAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42041-8220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-571-2920
Provider Business Mailing Address Fax Number:
270-744-8647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 NOLAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42041-8220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-571-2920
Provider Business Practice Location Address Fax Number:
270-744-8647
Provider Enumeration Date:
07/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KELLEY
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
270-472-8342

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1007 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 55000525 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56020118 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 406590094 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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